Depression in blepharospasm: a question of facial feedback?

Abstract

Janis Rebecca Bedarf,1 Sied Kebir,1,2 Joan Philipp Michelis,1,3 Bettina Wabbels,4 Sebastian Paus1 1Department of Neurology, University of Bonn, Bonn, 2Department of Neurology, University of Essen, Essen, Germany; 3Movement Disorders Center, Department of Neurology, Bern University Hospital, Bern, Switzerland; 4Department of Ophthalmology, University of Bonn, Bonn, Germany Abstract: Depression is the most important nonmotor symptom in blepharospasm (BL). As facial expression influences emotional perception, summarized as the facial feedback hypothesis, we investigated if patients report fewer depressive symptoms if injections of botulinum neurotoxin (BoNT) include the “grief muscles” of the glabellar region, compared to treatment of orbicularis oculi muscles alone. Ninety BL patients were included, half of whom had BoNT treatment including the frown lines. While treatment pattern did not predict depressive symptoms overall, subgroup analysis revealed that in male BL patients, BoNT injections into the frown lines were associated with remarkably less depressive symptoms. We hypothesize that in BL patients presenting with dystonia of the eyebrow region, BoNT therapy should include frown line application whenever justified, to optimize nonmotor effects of BoNT denervation. Keywords: botulinum neurotoxin, blepharospasm, depression, facial feedback, frown lines, grief muscles

Keywords

• Botulinum neurotoxin
• blepharospasm
• depression
• facial feedback